ONS Featured in Greenwich Sentinel

sentinel_logo_transparentYou can learn about the early days of ONS and the philosophy that made us the most comprehensive and advanced practice the region. The writer, Sara Poirier Correa, did an excellent job explaining that with 22 top sub-specialty trained physicians, ONS is able to provide personalized services to patients. The article also highlights the Women’s Sports Medicine Center and the ONS Foundation for Clinical Research and Education, which has published internationally and competes among researchers at larger universities such as Harvard, Yale, and Johns Hopkins. http://bit.ly/1PNTkfh

 

ONS Orthopedic Surgeon and Hand Specialist, Mark Vitale, MD Presents at 69th Annual American Society for Surgery of the Hand (ASSH)

Dr Vitale Portrait -sm web
Mark Vitale, MD

September 19, 2014, ONS orthopedic hand surgeon Dr. Mark Vitale traveled to Boston at the 69th annual American Society for Surgery of the Hand (ASSH), the premier annual hand surgery meeting where the nation’s leading hand surgeons gather to present new research and techniques for the care of hand, wrist, nerve and upper extremity problems.

Dr. Vitale presented two of the conferences’ 84 podium presentations to the community of hand surgeons in the U.S. and abroad. One of his presentations entitled, “Intra-articular fractures of the sigmoid notch of the distal radius: an analysis of progression to distal radioulnar joint arthritis and impact on upper extremity function in surgically treated fractures,” was a study that looked at fractures of one of the understudied joints of the wrist. This study will help surgeons guide treatment of these fractures to optimize wrist function in surgically treated fractures.

Traditional treatments for thumb arthritis involve removing the arthritic bone in the wrist called the trapezium which forms a joint with the base of the thumb and then using part of a patient’s own tendon to reconstruct the thumb. Dr. Vitale’s research revealed that the results with this more traditional “trapeziectomy” surgery are excellent and time tested.21

Dr. Vitale Speaking at the ASSH His second presentation, “A comparison of pyrolytic carbon hemiarthrioplasty versus Thompson suspensionplasty in the treatment of trapezial metacarpal arthritis,” was a study that compared a traditional treatment for thumb arthritis with a new pyrocarbon joint replacement for the thumb.

Pyrolytic carbon joint replacement is a synthetic implant to replace the arthritic thumb/wrist joint that was initially developed and first used in conjunction with hand surgeons at the Mayo Clinic in Rochester, MN. It resurfaces the base of the arthritic thumb metacarpal bone while leaving more of the native trapezium bone in place. The pyrolytic joint replacement implant has been used since the early 2000s. The result of this study found some improved function in patients treated with the pyrocarbon joint replacement, but also a higher risk of need for future surgeries in those treated with the newer joint replacement.

Hand surgeons today debate about what surgical procedures are most appropriate for severely arthritic thumbs. The results of Dr. Vitale’s research will now help guide surgeons around the country to better treat patients.

Dr. Vitale commented, “The ASSH conference was a great success. The ONS Foundation for Clinical Research and Education has provided us with an incredible state of the art research and biomechanics lab from which we continue to drive the field of hand surgery, sports medicine and orthopedic surgery.”

Orthopaedic and Neurosurgery Specialists PC (ONS) is an advanced multi-specialty orthopedic and neurosurgery practice in Greenwich, CT. ONS physicians provide expertise in sports medicine, minimally invasive orthopedic, spine and brain surgery, joint replacement and trauma. For more information, please visit www.onsmd.com.

Train Right, Run Free! ONS Physical Therapist Alicia Hirscht Shows Us how to Train for a Marathon

The ONS Foundation’s Annual 5K Run/Walk is coming up this Sunday, September 21st in Old Greenwich! ONS supporters, staff and former patients will participate in this fun-filled event. It would be great to see you all come down and enjoy a nice morning jog. Some of you may be casual joggers, others might want to participate in the local race circuit, or you might be training for the NYC Marathon.

ONS Senior Clinical Specialist Alicia Hirsch
ONS Senior Clinical Specialist Alicia Hirsch

Whether you are a casual runner, training for the marathon, or just someone who supports local causes with a 5K run…all runners are at risk of developing injuries if they are not training properly. A question I ask all my runners in the clinic is, “What else do you do for training, besides running?” More often than not, the answer is, “nothing” or “I stretch sometimes.”  What many runners do not know is that research has shown an effective leg and core strengthening program can reduce the incidence of hip, knee and ankle pain.

A proper program needs to have exercises specific for running: weight bearing on one leg, focused on shock absorbing muscle groups, and emphasizing hip and core strength. Many runners feel that stretching in their training can help prevent injury. However, many injuries occur because of inherent muscle weakness, not necessarily because of tightness.  To address this weakness, incorporate the exercises below into your routine: 3 times per week. Good luck with your training!

 

Hamstring Curls with the Ball:

1. Lie on your back with your legs up on a ball.

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2. Lift your hips, bend your knees and roll the ball in towards your buttocks.

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3. Roll the ball back out and lower your hips.

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One Legged Bridges:

1. Lie on your back with one knee bent, the other straight in the air.

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2. Pushing through the bent knee, lift your hips off the ground. Lower back down.

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Repeat: 3 sets of 15 reps on each leg.

 

 

 

 

 


Sideplanks:

1. Lie on your side, heels in line with your shoulders.

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2. Supporting yourself on your elbow, lift your body off the ground. Lower back down, repeat:

 

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3. Lower back down, repeat:

 

 

 

Hip Dips:

 1. Stand on your left leg only.

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2. Let your trunk bend forward while extending your right leg straight back. Let your arms fall freely, keep your left knee slightly bent. Keep your stomach muscles tight and your back in neutral, bend through your hip.

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3. Return to start position, repeat: 2 sets of 15 reps on each leg.

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One Legged Heel Raises:

1. Stand off the edge of a step, letting your heel hang below the step.

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2. Push up onto your toes. Lower back down slowly.

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Repeat: 3 sets of 15 reps on each leg.


Lateral Squats:

1. Stand sideways on a step.

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2. Sit your hips back and bend your knee, lowering your opposite leg to the ground. Do not let your knee fall inward and do not let it bend past your toes.

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3. Lift back up and repeat: 2 sets of 15 reps


Orthopaedic and Neurosurgery Specialists PC (ONS)
is an advanced multi-specialty orthopedic and neurosurgery practice in Greenwich, CT. ONS physicians provide expertise in sports medicine, minimally invasive orthopaedic, spine and brain surgery, joint replacement and trauma. For more information, please visit www.onsmd.com.

ONS Sports Medicine Specialists and Orthopedic Surgeons awarded 2nd place at The American Orthopaedic Society for Sports Medicine Meeting for “Incidence of Culture Positive Propionibacterium Acnes in Shoulder Arthroscopy”

UNDERSTANDING AND PREVENTING SURGICAL SITE INFECTION

The American Orthopaedic Society for Sports Medicine (AOSSM) was founded primarily as a forum for research and education for orthopedic surgeons, physicians and health care professionals in the field of sports medicine. Each year the AOSSM holds a conference to highlight areas of recent research, surgical techniques and to debate and share clinical insights about hot topics in the field of sports medicine. Physicians are recognized and awarded for their efforts in research and presentations about sports medicine conditions.

At the annual AOSSM meeting held in Seattle, Washington this July 10th-13th, ONS orthopedic surgeons Timothy Greene, MD, Katie Vadasdi, MD, director of the ONS Women’s Sports Medicine Center and Paul Sethi, MD, President of the ONS Foundation for Clinical Research and Education, were awarded 2nd place for research presented on “Incidence of Culture Positive Propionibacterium Acnes in Shoulder Arthroscopy.” This research is best described in a statement below from Dr. Paul Sethi:

“As the field of shoulder surgery and, particularly, shoulder replacement grows, the risk of developing shoulder infection increases. When treated imperfectly, infection may cause devastating complications. Our goal is to help develop a universal measure to absolutely minimize post-surgical infection. Reducing complications adds value to patient experience and avoids the costly road of infection eradication. The bacterium (Proprionibacter Acnes) most commonly attributed to shoulder infection is a very unusual organism. Until recently, it was not properly recognized because it was so difficult to identify.

Now that one of the greatest bacterial offenders (in the shoulder) has been more clearly identified, we are looking for ways to prevent it from infecting patients. In our last study we took over three hundred cultures and studied them. After careful analysis, we were able to identify when (during surgery) patients are most susceptible to this bacterial infection and were able to determine just how frequently this bacteria is present. Now that we know when this bacterium may gain its access to patients, we are developing ways to attack it at the patient’s point of vulnerability.”

Paul Sethi, MD
Paul Sethi, MD
Katie Vadasdi, MD
Katie Vadasdi, MD
Timothy Greene, MD
Timothy Greene, MD

Sethi PM, Greene T, Vadasdi K, Miller S.  Incidence of P. Acnes Culture after Primary Shoulder Arthroscopy.  AOSSM Annual Meeting. Seattle, WA. July 2014

Posters are judged by the AOSSM Education Program Committee. With just three poster awards available, we congratulate our physicians on their research and 2nd place award.

ONS Foundation Awarded 2nd Place in AOSSM Poster Contest
ONS Foundation Awarded 2nd Place in AOSSM Poster Contest

For more information on the AOSSM Annual Meeting, please click here: http://www.sportsmed.org/Education/Meetings/Annual_Meeting_2014/2014_Annual_Meeting/

Program:
http://www.sportsmed.org/uploadedFiles/Content2/Education/Meetings/Annual_Meeting_2014/AOSSM%202014%20Final%20Program.pdf

Orthopaedic and Neurosurgery Specialists PC (ONS) is an advanced multi-specialty orthopedic and neurosurgery practice in Greenwich, CT. ONS physicians provide expertise in sports medicine, minimally invasive orthopaedic, spine and brain surgery, joint replacement and trauma. For more information, please visit www.onsmd.com.

 

 

Is the Screwball Pitch Hard on the Arm? ONS Orthopedic Surgeon Paul Sethi, MD Weighs In

BaseballWhen you think of baseball pitchers, what comes to mind? Fastball? Curveball?

These are common terms used to describe pitches thrown during Major League Baseball games. Professional pitchers that have perfected these two conventional styles may not have the special skill and expertise to pull off one of the most, if not the most difficult pitches in baseball history, the screwball.

New York Times article The Mystery of the Vanishing Screwball,” by Bruce Schoenfeld, describes the “screwball” as “erratic, irrational or illogical, unexpected.”

In his article, Schoenfeld writes about the screwball technique gleaning inside information from Hector Santiago of the Los Angeles Angels who says the secret to the pitch is “like driving with your right wheels going around a curve.”

Schoenfeld goes on to write that “Unlike the knuckleball, which is easy to throw but hard to master, the screwball requires special expertise just to get it to the plate. The successful screwball pitcher must overcome an awkward sensation that feels like tightening a pickle jar while simultaneously thrusting the wrist forward with extreme velocity.”

Chicago White Sox pitching coach Don Cooper is quoted in the article saying “the word on the street is that the screwball is hard on the arm.” Although there is no documentation of this, many experts continue to debate as to whether or not the intensity of such a throw is harmful to the arm.

According to the article, Schoenfeld found no existing research to help answer the screwball pitch question. That’s when he contacted ONS Orthopedic Surgeon and Sports Medicine Specialist Paul Sethi, MD.

Dr. Paul Sethi, a Connecticut orthopedist, was willing to help generate some new data. Sethi is a disciple of Dr. Frank Jobe, the man who did an ulnar collateral graft in Tommy John’s elbow in 1974 and so created the most famous baseball-medical connection since Lou Gehrig’s disease.

Dr. Paul Sethi
Paul Sethi, MD

I met Sethi at the Center for Motion Analysis in Farmington, Conn., in a 108-foot-long room as bright as an operating theater. A dozen cameras were mounted on the walls. A tattooed 26-year-old named Matt Bartolomei stood on a portable pitcher’s mound while technicians adhered sensors to his body.”

Dr. Sethi, along with a team of experts, were able to watch in slow motion and concluded that the force exerted on the elbow of the pitcher when he threw a screwball during the experiment was identical to that of a fastball or curveball.

“In fact, the screwball doesn’t exceed the fastball in any parameter.” The results were hardly definitive, especially given the data set of one. “But looking at the data compared to the normative data kind of makes me tingly,” Sethi said.

If he and Nissen could confirm the conclusions, Sethi believed they might rescue the screwball from near-extinction. While assisting Jobe in Los Angeles, he worked with Dodgers pitchers. He liked the idea of contributing to their cause. I was less certain, though, that a doctor could revive the flat lining screwball. For a pitch to be used regularly by major leaguers, or even Little Leaguers, it needed a stronger selling point than mere safety.”

Although the “screwball” has been somewhat “abandoned” by baseball, the research conducted by Dr. Sethi and the team he worked with could make for a comeback. In a phone message yesterday Dr. Sethi confirmed, “the “screwball” pitch isn’t a cause for higher risk of injury than that of a fastball or knuckleball. It puts the same amount of stress on the arm as the other pitches do.”

Paul Sethi, MD is a board-certified orthopedic surgeon who specializes in sports medicine, the shoulder and elbow. He served as an orthopedic consultant to the Los Angeles Dodgers baseball team. Sethi was also a former assistant team physician of the Los Angeles Lakers basketball team, Los Angeles Kings hockey team, Los Angeles Dodgers, and University of Southern California football team.

Orthopaedic and Neurosurgery Specialists PC (ONS) is an advanced multi-specialty orthopedic and neurosurgery practice in Greenwich, CT. ONS physicians provide expertise in sports medicine, minimally invasive orthopaedic, spine and brain surgery, joint replacement and trauma. For more information, please visit www.onsmd.com.

[Read Full New York Times Article]

ONS Sports Medicine Specialist, Gloria Cohen, MD on Cycling Injuries

GloriaCohenbikingWEB_SMLike all activities engaged in regularly, cycling has its share of common ailments and injuries.  Many of the overuse injuries result from attempting to do too much, too soon. Poor riding technique, and improper frame fit for the individual may also cause injuries. Riding too many miles or tackling too many hills in too high a gear will stress the musculoskeletal system, especially at the start of the cycling season.

Knee pain is the most common complaint and is usually related to the tracking of the kneecap, or “patella” in the mid-groove of the thigh bone or “femur.”  The symptoms of “biker’s knee,” also known as “patellofemoral pain syndrome,” usually result from a combination of malalignment of the extensor mechanism of the knee, muscle imbalance, and improper set-up on the bike.  Each cyclist presents with differences in biomechanics (flat pronated feet, bow legs, etc.) and muscle conditioning (strength and flexibility) that can predispose to this condition.  It is important to avoid riding with high pedal resistance at a low cadence as this puts excessive pressure across the knee joint. The rule of the road is “if the knees hurt gear down.”

Some common riding errors are riding with the saddle too low or too far forward and poor foot position or improper cleat adjustment.  This can lead to other musculoskeletal injuries such as neck problems, or Achilles tendinitis.

We must not forget that traumatic injuries can occur when we least expect it. Wear an approved bicycle helmet at all times while cycling. Remember to replace your helmet if you are involved in a bike crash while wearing it. It will likely not perform for you the second time.

Gloria Cohen, MD is a specialist in non-operative sports medicine. She is a primary care team physician for the Columbia University varsity athletic teams and lecturer in the Department of Orthopaedics at Columbia University and served as team physician to the Canadian National Olympic Cycling Team for 14 years and was a member of the Canadian Medical Team for the Olympic Games in Seoul, Atlanta, and Sydney. She travels regularly with the Columbia University varsity football team, the Lions and is recognized as an authority in sports medicine in the United States and Canada.

Dr. Cohen believes in taking an integrative approach to medical management by considering a patients’ bio-mechanics, cardio-vascular and pulmonary function as it relates to athletic performance. Dr. Cohen is a successful competitive runner who has qualified twice for the New York Marathon. She is also an off-road and road cyclist and will be a featured speaker at Cycle Strong! A Sports Conditioning and Injury Prevention Workshop for Cycling Enthusiasts! This event is presented by ONS Foundation for Clinical Research, Inc. and sponsored by the North Castle Library, Armonk. For more information visit the ONS Foundation website.

Orthopaedic and Neurosurgery Specialists, PC (ONS) physicians provide expertise in the full spectrum of musculoskeletal conditions and injuries, sports medicine, minimally invasive orthopedic, spine and brain surgery, joint replacement and trauma. The main office is located at 6 Greenwich Office Park on Valley Road, Greenwich, CT. For more information, visit https://onsmd.com/ or call 203.869.1145.